Jang Sung Ill, Sung Se Yong, Park Hyunsung, Lee Kwang-Hun, Joo Seung-Moon, Lee Dong Ki
Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea Department of Medicine, The graduate school of Yonsei University, Seoul, South Korea.
Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Therap Adv Gastroenterol. 2017 Mar;10(3):297-309. doi: 10.1177/1756283X16685059. Epub 2017 Jan 11.
Recently, there has been an increase in clinical success rates using nonsurgical methods to resolve anastomotic biliary strictures (ABSs) that develop after liver transplantation (LT). However, some strictures are particularly refractory and cannot be completely resolved by an endoscopic or percutaneous procedure. Consequently, the aim of this study was to examine the feasibility and efficacy of using a newly designed fully covered self-expandable metal stent (FCSEMS) to resolve refractory ABS.
A total of 35 patients with an ABS that developed after LT, but could not be resolved by an endoscopic or percutaneous procedure, were included in this study. FCSEMSs were positioned endoscopically and removed after 2-3 months. After stent removal, the patients were followed to assess complications, including re-stenosis.
The mean period from LT to stricture was 13.7 months, and the mean duration of the stricture was 31.8 months. The type and mean number of procedures previously attempted were endoscopic retrograde cholangiopancreatography (ERCP) (9.1 ± 5.1) in 19 patients and percutaneous transhepatic biliary drainage (9.2 ± 4.8) in 16 patients. All patients had successful FCSEMS insertions and removals; the mean stent indwelling time was 3.2 months. The mean follow-up period was 18.7 months (range: 6.4-37.8 months). Stricture recurrence was observed in 6 of 29 patients (recurrence rate: 20.7%). The anastomotic stricture resolved with the FCSEMS insertion in 29 of 35 patients (clinical success rate: 82.9%).
The newly designed FCSEMS is a potentially feasible and effective treatment for anastomotic strictures that develop after LT but are not amenable to treatment by conventional procedures.
最近，使用非手术方法解决肝移植（LT）后发生的吻合口胆管狭窄（ABS）的临床成功率有所提高。然而，一些狭窄特别难治，无法通过内镜或经皮手术完全解决。因此，本研究的目的是探讨使用新设计的全覆膜自膨式金属支架（FCSEMS）解决难治性ABS的可行性和疗效。
本研究纳入了35例LT后发生ABS但无法通过内镜或经皮手术解决的患者。通过内镜放置FCSEMS，并在2 - 3个月后取出。取出支架后，对患者进行随访以评估并发症，包括再狭窄。
从LT到狭窄的平均时间为13.7个月，狭窄的平均持续时间为31.8个月。先前尝试的手术类型和平均次数为：19例患者进行内镜逆行胰胆管造影（ERCP）（9.1±5.1）次，16例患者进行经皮肝穿刺胆道引流（9.2±4.8）次。所有患者FCSEMS的置入和取出均成功；支架平均留置时间为3.2个月。平均随访期为18.7个月（范围：6.4 - 37.8个月）。29例患者中有6例观察到狭窄复发（复发率：20.7%）。35例患者中有29例FCSEMS置入后吻合口狭窄得到解决（临床成功率：82.9%）。
新设计的FCSEMS对于LT后发生但不适合传统手术治疗的吻合口狭窄是一种潜在可行且有效的治疗方法。
